In light of the web notification from the Food and Drug Administration (FDA) regarding a possible connection between meningitis and cochlear implants, consider the following suggestions:
Inform patients. "We sent a mailing to all patients and parents of pediatric patients telling them we’re aware of problem, telling them it’s infrequent," says Noel L. Cohen, MD, Mendic Foundation professor and chairman in the Department of Otolaryngology at New York University School of Medicine in New York City. The letter from Cohen included this information:
1. All patients with cochlear implants are advised to be vaccinated against meningitis. Cohen says this is particularly important in the following groups:
A. All children younger than 5 should receive the pneumococcal conjugate vaccine (Prevnar, Wyeth Pharmaceuticals, Philadelphia). This already is a recommendation of the American Academy of Pediatricians.
B. Implanted patients with abnormal inner ears (e.g. Mondini's deformity, common cavity, large vestibular aqueduct), those who have received a two-component electrode, and those whose immune status is inadequate should be appropriately vaccinated depending on age, by the pediatrician, family physician, or internist.
2. All ear infections in implanted patients should be immediately and vigorously treated by their physician, in consultation with their implant surgeon.
3. No additional surgery is required.
In addition, Cohen’s facility has scheduled a forum on the evening of Sept. 18 to inform patients and answer questions.
Consider offering additional sources of information to patients, suggests Nancy M. Young, MD, head of the Section of Otology at Children’s Memorial Hospital in Chicago. Young sent a letter to all her patients that included a list of web sites that she obtained from the web site for Advanced Bionics Corp. in Sylmar, CA. (Web: www.bionicear.com. Click on "Information on Meningitis and Cochlear Implantation.") Also, Young is drafting a letter for new patients and is going to send a letter that discusses the issue in detail to new patients’ pediatricians.
Urge patients to share copies of the notification with their family physician. One of the concerns with the possible connection between cochlear implants and meningitis is that when people have a fever or cold, they go to a family physician, says Peg Williams, PhD, executive director of the Cochlear Implant Association in Washington, DC. "They may not think to call their ear, nose, and throat doctor," Williams says. For that reason, cochlear implant centers may want to ask patients to provide a copy of the FDA notification to their family physicians, she advises.
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